RI 38-128 June 2010 Markup

U.S. Office of Personnel Management
Retirement Services and Management Group
Post Office Box 440
Boyers, PA 16017-0440

Form Approved
OMB No.: 3206-0226

Date:

It's Time to Sign Up for Direct Deposit
Public Law 104-134 requires that most Federal payments be made by Direct Deposit. More than 90% of Federal
retirees and survivors receive their payments by Direct Deposit. We recommend that you participate too.
We can make payment by Direct Deposit into your account in a bank, credit union, savings bank, or thrift institution.
Many financial institutions offer basic, low-cost accounts, as well as full-service accounts. Direct Deposit is safe,
reliable, and convenient for you. You do not have to take care of a paper check (which could be delayed in the mail,
lost, or stolen).
However, if receiving your payment electronically would cause you a hardship because you have a disability or
because of a geographic, language, or literacy barrier, you may receive your payment by check. In addition, if
enrolling in Direct Deposit would cause you a financial hardship because it would cost you more than receiving your
payment by check, you may receive your payment by check.
For more information about Direct Deposit, call us on 1-888-767-6738 (TDD: 1-800-878-5708) Monday through Friday
from 7:30 AM to 7:45 PM Eastern time. It is easy to sign up. You can call us toll-free using the numbers shown above.
If you do not want to call us to enroll, you can fill this form out and FAX it to 724-794-6633. Or, you can mail this form
to our Boyers, Pennsylvania, address shown at the top of this page.

Retirement Operations
Enclosure: Return Envelope
Public Burden Statement
We estimate this form takes an average of 30 minutes to complete, including the time for reviewing instructions, getting the needed
data, and reviewing the completed form. Send comments regarding our estimate or any other aspect of this form, including
suggestions for reducing completion time, to the Office of Personnel Management, Retirement and Benefits Publications Team
(3206-0226), Washington, DC 20415-3430. The OMB Number 3206-0226 is valid. OPM may not collect this information, and you are
not required to respond, unless this number is displayed.

Prior versions of this form are not usable.

RI 38-128
Revised June 2010

Applicant's name

Claim number

Direct Deposit Information
To have your annuity payments made by Direct Deposit, please complete Section A. You may also receive Direct
Deposit by calling us or by completing a Standard Form 1199A (available at most financial institutions). If you want
payments by check, please complete Section B.

Section A - Payment by Direct Deposit
I want to receive my annuity payments by Direct Deposit into the account indicated below.
Account Information - Please contact your financial institution to obtain accurate and complete account and routing
numbers. If you prefer, you may attach a voided check instead of entering the account and routing numbers.
However, we cannot accept a deposit slip for this purpose.
Account type

Account number

Checking
Savings
Financial institution routing

Name, address and telephone number of your financial institution

(

)

Your signature*

Your daytime telephone
number

(

Your Email address

Date

)

Section B - Payment by Check
Please pay me by check; Direct Deposit would cause me a hardship as described on the other side of this notice. I
understand that I may sign up for Direct Deposit at any time.
Your signature*

Your daytime telephone
number

(

Your Email address

Date

)

*You must sign. We cannot accept the signature of a person holding your power of attorney. We can accept the
signature of an OPM-approved representative payee or a court-appointed fiduciary, if we have a copy of the court
appointment.

Reverse of RI 38-128
Revised June 2010